Cancer Causes & Control最新文献

Purpose: Obesity in mid-life is a well-established risk factor for developing renal cell carcinoma (RCC); however, patients with RCC who are obese at the time of diagnosis have more favorable survival outcomes. To get better insight into the obesity paradox and determine the extent to which weight around diagnosis is stable, we examined pre- and post-diagnosis weight changes in patients with localized RCC.

Methods: We included 334 patients with localized RCC from the prospective cohort ReLife who self-reported body weight at multiple time points ranging from 2 years before to 2 years after diagnosis. Multivariable linear mixed-effects regression models were used to compare weight at each timepoint to weight at diagnosis for the overall study population, as well as stratified by BMI at diagnosis, tumor stage, and tumor grade.

Results: Most patients were classified as overweight (38.3%) or obese (29.6%) at diagnosis. Overall, patients experienced on average 1.45 kg (95% confidence interval (CI) 0.84, 2.06) weight loss in the 2 years before diagnosis. Pre-diagnosis weight loss was higher in patients who were non-obese at diagnosis, and who presented with higher tumor stage and grade. On average, pre-diagnosis weight loss was at least partially regained within two years after diagnosis.

Conclusion: Patients who were non-obese and patients with higher stage and grade tumors had higher pre-diagnosis weight loss, which was at least partially regained after treatment. These patterns suggest there are subgroups of patients with localized RCC who experience disease-related weight loss, which could contribute to the obesity paradox.

Purpose: Historical redlining, a 1930s-era form of residential segregation and proxy of structural racism, has been associated with breast cancer risk, stage, and survival, but research is lacking on how known present-day breast cancer risk factors are related to historical redlining. We aimed to describe the clustering of present-day neighborhood-level breast cancer risk factors with historical redlining and evaluate geographic patterning across the US.

Methods: This ecologic study included US neighborhoods (census tracts) with Home Owners' Loan Corporation (HOLC) grades, defined as having a score in the Historic Redlining Score dataset; 2019 Population Level Analysis and Community EStimates (PLACES) data; and 2014-2016 Environmental Justice Index (EJI) data. Neighborhoods were defined as redlined if score ≥ 2.5. Prevalence quintiles of established adverse and protective breast cancer factors relating to behavior, environment, and socioeconomic status (SES) were used to classify neighborhoods as high-risk or not. Factor analysis grouped factors into domains. Overall and domain-specific scores were calculated for each neighborhood according to historical redlining status. Percent difference in score by historical redlining was used to assess differences in average scores, with Wilcoxon-Mann-Whitney test used to estimate significance. Kappa statistic was used to estimate concordance between historical redlining status and high-risk status. Heatmaps of scores were created to compare spatial clustering of high-risk factors to historical redlining.

Results: We identified two domains: (1) behavior + SES; (2) healthcare. Across the US, redlined neighborhoods had significantly more breast cancer factors than non-redlined (redlined neighborhoods = 5.41 average high-risk factors vs. non-redlined = 3.55 average high-risk factors; p < 0.0001). Domain-specific results were similar (percent difference for redlined vs. non-redlined: 39.1% higher for behavior + SES scale; 23.1% higher for healthcare scale). High-scoring neighborhoods tended to spatially overlap with D-grades, with heterogeneity by scale and region.

Conclusion: Breast cancer risk factors clustered together more in historically redlined neighborhoods compared to non-redlined neighborhoods. Our findings suggest there are regional differences for which breast cancer factors cluster by historical redlining, therefore interventions aimed at redlining-based cancer disparities need to be tailored to the community.

Objectives: Automated breast ultrasound imaging (ABUS) results in a reduction in breast cancer stage at diagnosis beyond that seen with mammographic screening in women with increased breast density or who are at a high risk of breast cancer. It is unknown if the addition of ABUS to mammography or ABUS imaging alone, in this population, is a cost-effective screening strategy.

Methods: A discrete event simulation (Monte Carlo) model was developed to assess the costs of screening, diagnostic evaluation, biopsy, and breast cancer treatment. The number of quality-adjusted life years gained through each screening method is assessed using previously published quality of life measures. Incremental cost-effectiveness ratios for screening with the combination of mammographic and ABUS imaging, and for ABUS imaging alone are calculated as compared to standard mammographic imaging.

Results: Combined screening with both mammographic and ABUS imaging results in an incremental cost-effectiveness ratio of $7,071 ($6,332-$7,809) when compared to traditional mammographic imaging (p < 0.05). ABUS screening alone results in an incremental cost-effectiveness ratio of $3,559 ($- 965-$8,082) when compared to mammographic imaging (p < 0.05). ABUS screening alone is more likely to be cost-effective for a willingness-to-pay of less than $7,100.

Conclusions: The addition of ABUS to mammographic imaging is a cost-effective screening strategy in women with increased breast density or who are at a high risk of developing breast cancer. ABUS imaging alone is also a cost-effective strategy in this population, particularly in resource-poor areas.

Purpose: The objective of our study was to evaluate bladder cancer risk among Lithuanian type 2 diabetes mellitus (T2DM) patients and the effect of antihyperglycemic therapy on bladder cancer risk.

Methods: We analyzed bladder cancer risk in a cohort of patients who were diagnosed with T2DM between 2001 and 2012 in Lithuania. Bladder cancer risk in four groups of antihyperglycemic medication users (insulin-only, metformin-only, sulfonylurea-only, and pioglitazone ± any other drug) was also assessed. Standardized incidence ratios for bladder cancer were calculated.

Results: A total of 76,818 patients (28,762 males and 48,056 females) with T2DM were included in the final cohort. In the whole cohort of diabetic patients, 277 bladder cancer cases were observed, compared to 232.75 expected cases, according to bladder cancer rates in the general population (Standardized Incidence Ratio 1.19; 95% Confidence Interval: 1.06-1.34). Higher risk of bladder cancer was found in both men and women; however, in women the risk increase was not statistically significant. We found higher risk of bladder cancer in patients of both sexes diagnosed with T2DM at the age of 50-79 years and also in all groups of different antihyperglycemic medication users.

Conclusion: T2DM was associated with increased risk of bladder cancer.

Background: The data on epidemiology of Human papillomavirus (HPV) infections in men are scarce relative to women generally, particularly among men engaging in heterosexual relationships. This study investigated the prevalence and risk factors for penile, anal, and oral HPV in men in two communities in Ibadan, Nigeria.

Methods: This was a cross-sectional survey involving a face-to-face interview, a clinical examination, and sample collection from participants. HPV genotyping was performed with Anyplex II 28 HPV assay. The prevalences and factors associated with HPV infections using multivariable models and concordance between sites.

Results: Of 316 men, the proportion of any HPV infection in the penile, anal, and oral sites was 40.5%, 9.7%, and 7.8%, respectively. The proportion of any high-risk HPV, low-risk HPV, and multiple HPV infections was highest in the penis followed by the anal and oral sites. Only 5/316 (1.6%) men had concordant HPV in all three sites, with the highest concordance in penile-anal sites relative to penile-oral and anal-oral sites. The odds of penile HPV were higher in men aged 25 years and above. Having penile HPV was associated with higher odds of detecting anal HPV and vice versa. Oral HPV was less likely in men not living with their sexual partners.

Conclusion: Penile HPV is the most common infection followed by anal HPV and oral HPV infections among heterosexual Nigerian men. Concordant HPV infections was highest in penile-anal sites. Nigerian men, as in other settings, are a reservoir of HPV and it is important to conduct more robust studies to appreciate their role in HPV transmission, epidemiology, and prevention.

Purpose: Physical activity (PA) can improve cancer survival; however, whether the timing of PA differentially affects mortality risk is unclear. We evaluated the association between PA levels pre- and post-diagnosis and mortality risk in the Women's Health Study (WHS), Physicians' Health Study (PHS)-I, and PHS-II prospective cohorts.

Methods: We categorized PA pre- and post-diagnosis as active (WHS: ≥ 7.5 metabolic equivalent (MET)-h/week; PHS: vigorous PA ≥ 2-4 times/week) or inactive. We analyzed changes in pre- and post-diagnosis PA levels as four joint categories: (1) Inactive → Inactive, (2) Active → Inactive, (3) Inactive → Active, and (4) Active → Active, on mortality risk using multivariable Cox proportional hazards regression.

Results: We identified 10,541 participants with incident cancer and 3,696 deaths during follow-up. Compared to maintaining inactivity in both periods, remaining active pre- and post-diagnosis observed lower all-cause (Hazard Ratio [95% confidence interval]: WHS: 0.55 [0.47-0.64]; PHS-I: 0.77 [0.67-0.88]), cancer (WHS: 0.55 [0.45-0.67]; PHS-I: 0.75; [0.61-0.92]) and non-cancer/cardiovascular disease (CVD) mortality risks (WHS: 0.49 [0.38-0.65]). Similarly, becoming active post-diagnosis was associated with lower all-cause (WHS: 0.60 (0.48-0.75]; PHS-I: 0.72 [0.61-0.88]), cancer (WHS: 0.65 [0.49-0.86]; PHS-I: 0.64 [0.49-0.84]), and non-cancer/CVD mortality risk (WHS: 0.49 [0.33-0.75]). Being active pre- and post-diagnosis was associated with lower mortality risks in separate analyses, although significance differed by cohort and outcome.

Conclusions: Remaining active pre- and post-diagnosis and becoming active post-diagnosis may be associated with improvements in cancer survival, however, research is needed across diverse cancer populations.

NEED: Cervical cancer is a major global public health issue, particularly affecting low and middle-income countries, distinctly in the South Asian region. This geographical region lacks a well-organized routine cervical screening program. Consequently, this scoping review aimed to investigate the evidence on factors influencing the adoption and implementation of routine cervical cancer screening in South Asia.

Methods: Adopting the "Arksey and O'Malley and Levac et al." methodology, databases such as PubMed, CINAHL, Web of Science, and Scopus were scrutinized in the pursuit of relevant studies. Subsequently, the collected data were synthesized by adopting the Consolidated Framework for Implementation Research (CFIR) model.

Results: A total of 837 records were initially identified and screened for eligibility, including 55 studies. The successful adoption and implementation of cervical cancer screening in South Asia encounter numerous obstacles within the health system, including the absence of a comprehensive program protocol for screening, inadequate health infrastructure, and the presence of multiple sociocultural factors, such as social stigma, low levels of education, and concerns related to modesty.

Conclusion: To optimize adoption and implementation, it is imperative to construct a customized policy framework that incorporates a risk communication strategy tailored to the specific contexts of these nations. Drawing insights from the experiences of South Asian countries in executing cervical cancer screening programs can inform the formulation of policies for similar healthcare initiatives aimed at facilitating the expansion of HPV vaccination efforts.

Purpose: Prostate cancer (PCa) is an increasing burden in Sub-Saharan Africa. This systematic review examined the incidence, prevalence, clinical characteristics and outcomes of PCa in Nigeria.

Methods: This review followed the standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Peer-reviewed observational studies that focused on epidemiology of PCa in Nigeria, published between 1990 and 2023 and written in English were eligible. Combination of keywords was used to search PubMed, Scopus, Google scholar, AJOL and web of science databases. A piloted form by the Cochrane Public Health Group Data Extraction and Assessment Template was used to extract data from retrieved studies. Quality assessment of included studies was performed using the Newcastle-Ottawa scale for observational studies.

Results: Of the 1898 articles retrieved, 21 met the inclusion criteria. All included studies showed good quality. Mean age for PCa ranged from 55 to 71 years, with a higher prevalence occurring within 60-69 years. A 7.7 fold increase in PCa incidence was reported for the years 1997-2006, while an average annual increase in incidence rate of 11.95% was observed from 2009 to 2013. Hospital-based prevalence of 14%-46.4% was observed for clinically active PCa. Patients presented for diagnosis with high Gleason scores and advanced PCa. High mortality (15.6%-64.0%) occurred between 6 months and 3 years of diagnosis.

Conclusion: Findings suggest rising incidence and high prevalence of PCa in Nigeria. Advanced PCa was most common at diagnosis and mortality was high. There is need for improved strategies and policies for early detection of PCa in Nigeria.

Purpose: We aimed to (1) determine the extent of coverage of colorectal cancer patients in Arkansas All-Payer Claims Database (APCD), (2) assess coverage difference between persistent poverty and other areas, and (3) identify patient, tumor, and area factors associated with inclusion in APCD.

Methods: Data were from 2018 to 2020 Arkansas APCD linked with 2019 Arkansas Central Cancer Registry (ACCR). We constructed four cohorts to assess APCD's coverage of CRC patients: (Cohort 1) ≥ 1 day of medical coverage in APCD in 2019; (Cohort 2) APCD coverage in the diagnosis month; continuous APCD coverage in the 30; Year around diagnosis (six months before to five months after diagnosis month) (Cohort 3); or until death within six months (Cohort 4). We compared proportions in the cohorts by area persistent poverty designation. Logistic regressions identified factors associated with inclusion in APCD cohorts.

Patient selection: CRC patients diagnosed in 2019 from ACCR, excluding in situ disease.

Results: Of the 1,510 CRC patients diagnosed in 2019, 83% had ≥ 1 day of medical coverage in 2019 APCD (Cohort1), 81% had coverage in the diagnosis month (Cohort 2), and 63% had continuous coverage in the year around diagnosis (Cohort 3). Additionally, 11% died within six months but had continuous coverage until death (Cohort 4, 74%). No coverage difference was found between persist poverty and other areas. Age and primary payer type at diagnosis were the main predictors of inclusion in APCD.

Conclusion: Arkansas APCD had high coverage of Arkansas CRC patients. No selection bias by area of persistent poverty designation was present.

Purpose: Clinical trials are essential to the advancement of cancer care. However, clinical trial knowledge and participation remain critically low among adult patients with cancer. Health information technology (HIT) could play an important role in improving clinical trial knowledge and engagement among cancer survivors.

Methods: We used data from 3,794 adults who completed the 2020 Health Information National Trends Survey, 626 (16.2%) of whom were cancer survivors. We examined the prevalence of HIT use in the study population and by cancer history using chi-squared tests. We used multivariable logistic regression models to examine the impact of HIT use on clinical trial knowledge for cancer survivors and respondents with no cancer history, respectively.

Results: Approximately 63.8% of cancer survivors reported having some knowledge of clinical trials. Almost half of the cancer survivors used HIT to communicate with doctors (47.1%) and make health appointments (49.4%), 68.0% used HIT to look up health information online and 42.2% used it to check test results. In the adjusted models, the use of HIT in communicating with doctors [OR 2.79; 95% CI (1.41, 5.54)], looking up health information online [OR 2.84; 95% CI (1.04, 7.77)], and checking test results [OR 2.47; 95% CI (1.12, 5.43)] was associated with having some knowledge of clinical trials.

Conclusion: HIT use for engaging with the healthcare team and health information gathering is associated with higher clinical trial knowledge in cancer survivors. Given the rapid increase in mobile technology access globally and the increased use of HIT, digital technology can be leveraged to improve clinical trial knowledge and engagement among cancer survivors.